Project Fiasco: An Analysis of Ontario's Electronic Health Record Project

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Abstract

Policy failure is a recurring theme in large government technology projects. The Ontario Electronic Health Record (EHR) project is one of the most recent, and high profile, Canadian examples.
The EHR project had two main phases – the design phase (in which the architecture of the system was determined) and an implementation phase (in which the operation of the system was carried out). This study has two objectives: first, to develop a set of frameworks that can be used to understand the design phase and the implementation phases; and second, to use these frameworks to describe and to understand why the EHR initiative was so unsuccessful.
To facilitate an understanding of the implementation phase of a project, a game theoretic framework is employed that classifies technology solutions as either independent or interdependent. When solutions are interdependent, the framework suggests that, in order to obtain the greatest value, the government should exert its authority to ensure the coordination and cooperation of the actors in the system.
To understand the design phase of a project, a framework is developed that links together the nature of the problem with the type of organization best suited to solving the problem. I argue that the complexity, or decomposability, of a problem directly affects the optimal method of a search for solutions, and the optimal means of organizing that search.
These two frameworks are then applied to Ontario’s EHR project to analyze why the EHR project was so unsuccessful. I conclude that decision makers failed to consider the interdependent nature of EHR solutions; instead, they encouraged independent actors to develop their own ehealth solutions, effectively undermining the provincial goal of an interoperable system. I also conclude that decision makers misdiagnosed the nature of the EHR problem, resulting in an ineffective search procedure to locate an EHR solution. These two errors resulted in a policy fiasco that was manifested in almost total project failure and a resulting high degree of public outrage. We also speculate on why these errors were made.